- Molina Healthcare (Columbus, OH)
- …payment integrity and other cost recovery processes + Direct PM experience in Managed Care Operations (claims, system configuration, provider data management ... + 3-5 years in Managed Care with emphasis on Managed Care Operations **Preferred License, Certification, Association** + PMP, CAPM, PMI-ACP, PMI-PBA… more
- JPMorgan Chase (Columbus, OH)
- …cross Line Of Business requests to include exposure to customers that are managed by units outside of the family responsibility area. + Coordinate all administrative ... meet employee needs, based on eligibility. These benefits include comprehensive health care coverage, on-site health and wellness centers, a retirement savings plan,… more
- Molina Healthcare (Columbus, OH)
- …+ 3 - 5 years customer service, provider service, or claims experience in a managed care setting. + 3-5 years' experience in managed healthcare ... DESCRIPTION** **Job Summary** Molina Health Plan Provider Network Management and Operations jobs are responsible for network development, network adequacy and… more
- Hilton (Columbus, OH)
- …hotels to our ever\-growing portfolio\! **What will I be doing?** As a Senior Director Management Contract Services, you will partner with owners and investors to ... grow Hilton's managed and franchised hotel portfolio\. On the Owner Relations...settle disputes, and addressing owner\-reported concerns by communicating with operations teams and responding promptly\. + Manage the entire… more
- Molina Healthcare (Columbus, OH)
- …analysis and transformation, specifically in processing healthcare claims data and supporting managed care reporting needs + Experience using **Power BI** for ... role supporting **utilization management, population health, or quality improvement within a Managed Care Organization (MCO)** + Experience working directly with… more
- Humana (Columbus, OH)
- …as Computer Science, Mathematics or Statistics and/or related field + Healthcare or managed care experience + Experience performing data management, mining, and ... we deliver world class solutions that address inefficiencies in the health care . The Senior Cognitive/Machine Learning Professional collaborates with analytic… more
- Molina Healthcare (Columbus, OH)
- …or equivalent combination of education and experience **Required Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or ... level (or higher) **Preferred Education** Bachelor's Degree **Preferred Experience** + 5+ years managed care experience + QNXT; SQL experience + Crystal Reports… more
- Western Digital (Columbus, OH)
- …needs * Facilitate technical requirements and maintain well-defined roadmaps with senior stakeholders **Legal Technology Leadership** * Serve as in-house expert on ... Change Management** * Continuously identify automation and innovation opportunities in legal operations * Track system usage, impact, and satisfaction metrics * Lead… more
- Molina Healthcare (Columbus, OH)
- …**Required Experience** + 5-7 years of business analysis experience, + 6+ years managed care experience. + Demonstrates proficiency in a variety of concepts, ... with multiple types of business data. May be internal operations -focused or external client-focused. **KNOWLEDGE/SKILLS/ABILITIES** + Elicit requirements using… more
- Molina Healthcare (Columbus, OH)
- …in billing, claims, encounters, and data analysis + 5 years or more of managed care experience + Knowledge of advanced data analysis techniques + Skilled ... with preparing portions of materials and information for Monthly Governance and Operations Reviews + Performs root cause analysis of claims and encounter data… more
- Highmark Health (Columbus, OH)
- …various complex potential claims with emphasis on controlling losses through effective managed care . This includes following a departmental claim checklist to ... the accuracy of client reports submitted to the organization, efficiency of claim operations , and adequacy of systems and procedures. + Approves claim payments on… more
- Centene Corporation (Columbus, OH)
- …**Education/Experience:** Current state RN license preferred. Previous experience in a managed care organization strongly preferred. 3+ years of leadership ... The Vice President of Population Health & Health Outcomes is a senior leadership role responsible for developing and executing strategies that drive measurable… more
- Molina Healthcare (Columbus, OH)
- …SKILLS & ABILITIES** : * 7+ years experience in Healthcare Administration, Managed Care , Provider Contracting and/or Provider Services, including 2+ years ... activities for the state health plan. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider… more
- Molina Healthcare (Columbus, OH)
- …**Required Experience** + 10+ years progressive experience in Healthcare Administration, Managed Care and/or Provider Services. + Experience managing employees. ... activities of the State Plan's Provider Network Management and Operations Department. Works with staff and senior ...related field. **Preferred Experience** Experience with Medicaid and Medicare managed care plans. \#PJHPO \#LI-AC1 To all… more
- Trinity Health (Columbus, OH)
- …Participates with the Senior Leadership Team of the RHM in all Managed Care strategies and negotiations. Participates in Senior Leadership Council ... strategic operations of the RHM. Works directly with the Senior Vice President of Clinical Care at Trinity Health in bridging the clinical arena of the RHM… more
- Prime Therapeutics (Columbus, OH)
- …as HIPAA, Anti-Kickback Statute, and False Claims Act, with a focus on PBM and managed care operations + Experience engaging with regulatory bodies (eg, CMS, ... company's brand and business + Provide strategic advice to senior leaders on the most complex legal scenarios +...of experience as an attorney and 5 years representing managed care companies, health care … more
- Evolent (Columbus, OH)
- …and proficiency + Personally initiate and foster executive level relationships at managed care organizations or health systems and large provider groups ... sales with long cycles requiring diverse stakeholder management + Knowledge of the managed care and provider markets (both payers and risk-bearing organizations)… more
- Evolent (Columbus, OH)
- …discussions . Experience building and developing team members . Knowledge of the managed care and oncology market trends (both payers and risk-bearing ... people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care … more
- UMB Bank (Columbus, OH)
- …assessment and underwriting of new SBCRE (Small Balance Commercial Real Estate) managed investment loans (non-owner occupied CRE loans $1,000,000 to $5,000,000) in ... suitable for each credit request. + Present loan submissions to the UMB senior loan committee on behalf of relationship managers and answer questions relative to… more
- Molina Healthcare (Columbus, OH)
- …years clinical systems experience, preferably as a product owner / manager within a managed care , nursing informatics or health care environment, or ... care management, long-term services and supports (LTSS), clinical operations and business processes. Considers business problems "end-to-end": including people,… more